Healthcare Provider Details

I. General information

NPI: 1265622583
Provider Name (Legal Business Name): LAUREL COUTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 E 10TH ST
INDIANAPOLIS IN
46201-2008
US

IV. Provider business mailing address

3403 E RAYMOND ST
INDIANAPOLIS IN
46203-4744
US

V. Phone/Fax

Practice location:
  • Phone: 317-633-7360
  • Fax: 317-633-7302
Mailing address:
  • Phone: 317-788-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01067954A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: